Framing alcohol harm in the UN context - the importance of language.

Background: Alcohol is a global health issue with a high level of controversy. After being absent from World Health Organization (WHO) global governing body discussions for about 20 years, alcohol re-entered the agenda in 2005. The expression 'harmful use of alcohol' became the compromise language after hard negotiations, an example of 'adopted language" that has remained for almost 20 years. This article analyses the background and use of the expression 'harmful use of alcohol' in the context of WHO governing bodies, current challenges and implications for public health.

Methods: The article is based on textual analysis of source documents from the time periods 2004-2010 and 2019-2022 and the authors' experience from involvement in the global alcohol policy scene for more than 20 years: WHO governing body records and other documents were analysed, as well as Member State and Non-State Actors' positions and contributions in consultations and statements in WHO governing body debates.

Results: The introduction of the concept 'harmful use of alcohol' in WHO documents from 2005 onwards was a political compromise between approaches focussed either on 'alcohol abuse' or a wider concept of harm from alcohol consumption. It has permeated into national alcohol policy documents, academic literature about alcohol harm and UN documents, and been embraced by the alcohol industry. However, it has not prevented and some would argue that it has enabled development of normative statements from WHO that include recommendations for population wide interventions. The relatively new evidence of harm from alcohol at low levels and questioning of evidence suggesting a beneficial effect of moderate use of alcohol together with industry appropriation of 'harmful use' have led to increasing critique of the framing implied by 'harmful use of alcohol'.

Conclusions: The language used in WHO documents holds political power in that it may influence the subsequent course of events. This is accentuated by the normative role of WHO in global health policy and the uptake of negotiated language beyond WHO documents. In the next five years it will be possible and valuable to examine in more detail the extent to which this power was made manifest and the need and possible ways to effect change.